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WEDNESDAY, Oct. 30, 2013 —Teens in New York City looking to light up a cigarette now have to wait until they can buy a beer to go with it, thanks to two new bills passed today by the New York City Council. The bills, called Tobacco 21 and Sensible Tobacco Enforcement, raise the minimum age to buy tobacco products from 18 to 21, the strictest of any major American city, and also institute other measures aimed at getting teens to stop smoking – measures that experts say will have a profound effect on the health of future generations.

The two bills were first proposed in April by City Council speaker and then-mayoral candidate Christine Quinn in an effort to curb the rate of teen smoking, which Susan Kansagra, MD , New York City’s deputy commissioner for Health Promotion and Disease Prevention says is one of the largest health problems facing the city.

“Teen smoking is a huge issue, especially given that if you ask current smokers, 80 percent started before they were 21,” Dr. Kansagra said.

Tobacco use is the leading cause of preventable death among all age groups in New York City, according to the New York City Department of Health, and since 2007, teen smoking rates have stalled. More than 19,000 high school students under the age of 18 currently smoke, and use of electronic cigarettes has doubled in high school students over the past two years.

Although no major cities have raised the smoking age this high, the idea of raising the tobacco buying age to 21 is not completely unprecedented. One city, Needham, Mass., raised the minimum tobacco buying age to 21, and since the law was enacted, the number of high school students in Needham who reported smoking declined by 50 percent – and the city expects to seem a similar effects, anticipating a 67 percent reduction in smoking in teens aged 14-17, and a 55 percent reduction in young adults aged 18-20.

“We think this will save lives in the future,” Kansagra said.

The new age restriction will go into effect in 6 months, with gradual rollouts of the other measures, Kansagra said.

Dan Ehlke, PhD, assistant professor of health policy and management at SUNY Downstate, said the change will likely make an impact on the teen smoking rate, but added that he remains skeptical as to just how big the impact will be.

“The evidence suggests that within several years of raising the legal age of purchase, consumption of tobacco goes down,” Dr. Ehlke said. “However, when it comes to alcohol, having a legal age of 21 doesn’t seem to make such a large difference in consumption.”

“There are very few negatives to raising the legal age,” Ehlke added, “especially because 60 percent of smokers agree with the idea. I’m just skeptical as to just how much of a positive difference this will make.”

But the smoking age isn’t the only thing that’s changing. The new laws will also increase penalties on retailers who sell tobacco to minors, prohibit discounts on tobacco products, and will set a minimum price of a cigarette pack to $10.50, which Ehlke said will have a profound effect on teen smoking.

“The rise in taxes on tobacco has been a big factor in decreasing consumption,” Dr. Ehlle said. “This change in price could have a larger difference than raising the age. It’s about hard economics and making hard choices when it comes to spending money.”

The law will also regulate cigarillos, or little cigars, that increasing numbers of young NYC smokers are turning to. Between 2001 and 2009, the number of smokers who reported using cigars or cigarillos tripled from 4.8 percent to 13.3 percent, likely because they are inexpensive at $1 to $2 each, according to data from the New York City Department of Health. These new laws mandate that cigarillos must be sold in packs of 20, likely putting them out of the price range for young smokers.

“Retailers are not able to sell loose cigarettes,” Kansagra said. “Little cigars are being sold loose and for change, so that makes them much more accessible to teens. Packaging them will help stop kids from trying them.”

But as cigarettes have become more difficult to obtain, more and more kids are switching to electronic cigarettes, Kansagra said. These new laws will also restrict the sale of these devices to people over the age of 21.

“There’s a concern that these products will addict a new generation to nicotine, and can lead to them trying other tobacco products,” she said. “These products are not currently regulated in anyway. It makes sense to protect our youths.”

Ehlke agreed, adding that e-cigarettes are the “wild west” of tobacco.

“Manufacturers are able to promote the health benefits of e-cigarettes, even though they still contain harmful chemicals,” he said. “One area we can make an impact is on the advertising and sale of e-cigarettes.”

New York City has taken strict measures against smoking, banning it in restaurants, public parks, and enacting the highest taxes on cigarettes in the country. With the new measures in place, Ehlke said there might not be much else the city can do.

“At some point, we reach a point of diminishing returns,” he said. “We may be approaching the limit.”

The good news, however, is that the measures seem be having an impact.

“A lot of the decrease in smoking we’ve seen has been of a result of public health education campaigns, including the graphic ads NYC runs on TV,” Ehlke said. “Smoking is also much less present in people’s everyday surrounding, so they don’t think about picking up the habit as much as they used to.”

Kansagra admitted that many 18-year-old smokers may be forced to quit under the new guidelines, but said that the city has smoking cessation aids available to any and all smokers.

“We offer smoking cessation services year round,” she said. “People just have to call 311 and say they want help quitting, and they’ll receive tips. If they’re eligible, they’ll also receive a course of nicotine patches.”

“We really hope that these bills will incentivize people to quit, or never start, smoking,” Kansagra added.

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